Application for Marriage Certificate or Registration ...

1 PARTY 1 DETAILSPARTY 2 DETAILSMARRIAGE CERTIFICATES AND Registration PHOTOCOPIES/EXTRACTSPAYMENT METHODDATE AND PLACE OF MARRIAGEYOUR RELATIONSHIP TO THE MARRIAGEB irthplace (City/Town/Village, Province/State, Country)VSA 430M 2019/07/15 Application FOR Marriage CERTIFICATES urname (before Marriage ) Given Name(s)OR Registration PHOTOCOPY/EXTRACTS urname (before Marriage ) Given Name(s) Birthplace (City/Town/Village, Province/State, Country)Month ( FEB)

2 Day Year City/Town/Village BRITISHCOLUMBIAS ignature:Reason Certificate Required: (*Requires written authorization from an eligible applicant.)Q of Marriage DocumentsCost Based on Delivery TypeEstimated Date of Delivery(Note: Add 2-3 weeks for processing time for new Marriage events.)

3 MailCourierMail Courier Marriage Certificate - Lists the full name, birthdate, birth place and sex of each party, the date and place of the Marriage , the Registration date and Registration number. Size: cm x cm.$27$60 Prints in 2 - 5 business days; add mailing time from Victoria to next business day; add courier delivery time from Victoria to Photocopy/Extract - Certified copy or extract of the Marriage Registration . $50$60 Prints within 20 business days; add mailing time from Victoria to next business day; add courier delivery time from Victoria to you. Courier delivery is not made to post office boxes, apartment complexes, homes that use Super Box (community) mailboxes, or basement suites.

4 Instead, a delivery notice withinstructions is left at the mailing address and the envelope is delivered to the nearest postal outlet. ID and signature are required upon pick *rrX MAILING ADDRESS AND CONTACT INFORMATIONCity/Town/Village, Province / State, Country Residential AddressSurnameGiven Name(s) Mailing Address (if different from residential address)Postal/Zip Code City/Town/Village, Province / State, CountryPostal/Zip Code Company and/or Individual NameHome phone (include area code)Work phone (include extension and area code)Signature:XrPRINT your name, address and identifying information clearly.

5 This portion is used when mailing your Certificate or correspondence. FOR OFFICE USE ONLY: AFS# Please bill my: Visa MasterCard American ExpressExpiry date:Amount Enclosed $_____ Credit Card #:Cheque or Money Order payable to the Minister of Finance. (Postdated cheques are not accepted.) Note: Credit card information is not retained. Upon authorization of the payment request, all credit card information is Card:X PRINT card holder name as shown on credit cardCard holder name:Interac/Cash payments can be made in person at a Service BC Centre.

6 Visit to find a location near holder signature: To save time, order your Marriage certificates securely online and pay with credit card. Go to: READ NOTES ON PAGE 2 OF THIS FORMI authorize the Vital Statistics Agency to mail correspondence and/or legal documents to the person/organization listed below.(Authorization required if mailing address is different from residential address.) Verify that you are eligible to request a Certificate (see Section 3 below). Write your complete address and telephone number clearly on your Application . To authorize the Vital Statistics Agency to send correspondence and the requested documents to a mailing address that is different from your residential address, you MUST check the box and provide your signature beside the statement provided on page one.

7 Without authorization, we cannot process your request. Complete all sections in full. If there is information you do not know, include the following three items with your Application : 1. A brief letter explaining why the information is unknown to you. 2. Photocopies of two pieces of identification (one piece should be picture ID). 3. Written verification of your identity on official letterhead from a physician, lawyer, notary public, or religious representative who has known you for at least two years. Enclose the correct payment in Canadian funds. Payments made by cheque or money orders should be made payable to the Minister of Finance.

8 Do not postdate cheques or send cash by mail. A service charge of $ will be levied on all cheques not honoured by the payee's financial institution. 1) FEES Fees listed on this form are determined under the Vital Statistics Act Regulation and are subject to change without notice. 2) INFORMATION PROVIDEDC ertificates are printed in UPPERCASE and contain the full name and sex of each party, date and place of the Marriage , the Registration date, and Registration number. Certified Electronic Extract of a Marriage Registration (Issued for all Marriage events occurring on or after January 1, 2000)This is an extract of the Marriage information on file with the Agency issued for Marriage events occurring on or after January 1, 2000.

9 This document cannot be used for identification purposes and is generally only required for court purposes. Certified Copy of a Marriage Registration (Issued for all Marriage events occurring prior to January 1, 2000) This is a copy of the original Marriage Registration completed at the time of Marriage . This document cannot be used for identification purposes and is generally only required for court purposes. If you require a certified copy or certified extract of a Marriage Registration , visit our website at or contact Customer Service at 250 952-2681 (Victoria & Outside ) or toll-free at 1 888 876-1633 (within ) for eligibility information.

10 3) WHO QUALIFIES TO APPLY FOR A Marriage Certificate ? Marriage certificates may be released to: Either party of the Marriage . A person who has written authorization from either party of the 430M 2019/07/15TO AVOID DELAY OTHER SERVICES - Genealogy Certificate ( RECORDS ONLY)To obtain an Application for a Genealogy Certificate , visit our website or contact us by 2 OF 2 IMPORTANT INFORMATIONTo save time, order death certificates securely online and pay with credit card. Go to: information is collected by the Vital Statistics Agency under section 26(c) of the Freedom of Information and Protection of Privacy Act and will be used to fulfill the requirements of the Vital Statistics Act for the release of Marriage information.